What High Quality Physio Should Look Like

If you are going to trust a healthcare provider with your recovery, it's important to know what distinguishes high quality from poor quality. After reading this post you should know the difference so you can ask the right questions before getting started. That way you never have to experience poor care!

What Poor Quality of Care Looks Like:

This is my rant for the month.  A good amount of the clients we see, come to us after having failed elsewhere or by another healthcare provider. Some have felt pretty much ready to give up and ‘just live with it, until they were talked into giving us a try by previous clients of ours.

In most cases these folks tell me that they were actually only seen briefly by their healthcare provider.  Maybe some quick hands on treatment, then out the door. Very little or no education/guidance was given on their injury or issue. Those who do have longer treatments tend to be passed off to a lesser qualified personnel or just left to do their exercises on their own most of the time (since the therapist/clinician was busy with other patients).

Needless to say the results were not what these folks were hoping they would be!

      image credit: www.glasbergen.com

     image credit: www.glasbergen.com

Generalized treatment leads to generalized results.

Delegated care leads to less educated professionals providing less skilled treatments.

Ultimately landing you with a watered down treatment approach that results in poorer outcomes and breakdown in communication...... Not to mention that these business usually try to make up for lesser quality of care by having you come in more frequently than necessary in hopes that their outcomes will improve at the expense of your precious time!

At On Track Physio, we guarantee this will not be your experience. We even back it with a money back "Love it or Leave it" guarantee! Something you never see  in healthcare..... If you’re going to spend your hard earned money on our services then it should be focused on YOU and the outcome you are trying to achieve!

Here is what High Quality of Care should feel like:

1) Time is actually taken to listen to and understand YOU, and your story about the path which lead you to your current state or current issue. 

2) Time is actually taken to allow you to ask questions

3) Time is taken to perform multiple assessments each and every visit to best ensure that the intervention given will be most likely to produce the outcome which is desired.

4) Time is taken to demonstrate, teach, and coach the exercise or intervention so it is done properly. But is also repeatable for you to do at home independently of a healthcare provider. This gives you the best possible chance of achieving the desired outcome.

5) Consistent communication throughout the entire plan of care to avoid setbacks.

6) Truly skilled clinical experience and knowledge/understanding of how the entire body works as a unit. Focusing on just the painful area will get results some of the time, but the majority of the time there is multiple contributing factors.

Note: Notice how items 1-4 emphasized time. If your provider is constantly juggling clients or passing you off between provider. Your TIME would be best spent elsewhere!

Obviously we are biased..... At On Track Physio we guarantee that we will show you all 6 of these traits to receive high quality care. If you would like to experience this quality of care, please feel free to reach out to us via phone, email, or schedule a time for a FREE Discovery session. This session is all about giving you the TIME needed to make a good choice in your health.

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Ann Arbor, Mi

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Snapping Hip

Recently I have had a string of clients present with a "snapping hip".

This isn't a medical diagnosis per say, but it is a symptom that many people deal with. The individual typically notices a random "popping", "clicking", or "snapping sound" from the front of their hip. It tends to feel different than cracking your knuckle, and it usually occurs when flexing the hip up. Or when they extend their hip back. 

Most people come to me and they say that they have tried a variety of different things before to help with it, but nothing seemed to make a difference. They have tried things such as stretching, strengthening, massage, dry needling, foam rolling, etc but no relief. 

No relief is noticed because using the above strategies did not address the problem.....So what is the problem?

I've treated many of these cases, and more times than not the individual will experience their symptoms in the following test:

The individual will notice a couple things...

1) The snapping either occurs as the thigh slowly lowers down...Or when the thigh is parallel to the ground and the individual flexes their hip back up toward the chest.

2) The individual will usually notice the thigh is able to get to a position that is parallel to the ground (so they have plenty of motion). But will have a tendency to want to move their leg out wider in this position or turn their foot outward because it feels more natural and comfortable.

So what's happening?

In my opinion this is a person who has put a lot of stress repetitively throughout the years to the front of their hip. As such, the individuals stabilization strategy is to compress at the front of the hip as opposed to utilizing their muscles properly to help keep the joint moving with proper congruence. 

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The picture above explains what Im talking about. You can see the joint roll across the muscle/tendon and that, in my opinion is what you are feeling. Some would say that this muscle is "tight". However, I would respectfully disagree....

Notice in the left picture how the joint faces us more. This is not optimal joint position. This is the strategy that you've most likely adopted to stabilize. Compressing and putting pressure on the front of the hip.

Now the fix for this is training a specific muscle called the glute med through full range of motion at the hip in all planes.

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Most people who have this feel a lot of quad and TFL activation with various exercises and even at rest. This is just more confirmation that you are front side biased in stabilizing the hip. They have a very hard time feeling the activation of a glute med muscle or musculature around that area when asked to perform certain hip strengthening activities.

Once the client learns how to feel this muscle, all of a sudden their symptoms tend to go away. Now this exercise is not just some simple squat or lunge. Trust me I wish it was....

Often times I spend 30 minutes to an hour just trying to teach someone how to feel this muscle work with a particular set of exercises.  But by the end of the session they notice a positive change in their symptoms and now they have homework to do.

If this sounds like you, or a friend, please share it with them. I'd love to set an appointment time up where we can talk about this in greater detail, and how On Track Physiotherapy can help. Just hit the discovery session button below to learn more.

Greg S.jpg

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Why Stretching Your Hip Flexor Isn't Alleviating Your Hip Pain

Have pain or discomfort in the front of your hip?

Does it hurt when you run, jump, sit, or squat?

Have you tried stretching the front of you hip out but only got about 2 seconds of relief from doing so?

Pain on the front side of the hip can be really annoying! It tends to start out at a low level discomfort that doesn't really impact you much...but it's just there! Then slowly and gradually you notice it impacting you more and more, eventually turning into an annoying toothache like symptoms in the front of your hip.

You've probably intuitively thought that this doesn't really feel like a muscle issue. It feels deeper than that. So you do what your high school gym teacher, trainer, coach, or even physical therapist told you to do.....stretch it out!

Only you notice about 2 seconds of relief.....Maybe 10 seconds if you hold the stretch for 10 seconds. But once you stop stretching the annoying toothache pain in the hip comes back.

Einstein said it best...."Insanity is doing the same thing over and over again, but expecting different results."

I see this all the time in the clinic, and have treated these cases successfully time after time. The first step is finding out if you shoulder STOP stretching the front of your hip. 

Watch this video to help you understand.

The first step in recovery is always to remove the provocative factors. Putting too much stress and pressure frequently throughout the day on the front side of the hip is quite frequently part of the problem. So we don't need to be feeding into it further by forcing the issue.

If you've been dealing with an issue similar to this, I'd like to invite you to schedule a free discovery session to dive more deeply into what SPECIFICALLY you need to be doing to get rid of the problem so that it doesn't turn into a bigger issue than what it's already become!

Real Solutions For Hip Pain| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Why Your Knee Hurts With Squats and Stairs

Pain in the front or side of your knee?

Clicking or popping around the kneecap?

Don't be so quick to blame the knee! We see this all the time at On Track Physiotherapy. Client comes in with knee pain and has difficulty with squatting, stairs, etc. 

Often times people think that this is a knee issue. When quite often it actually has more to do with the hips and foot than anything. 

When people think about the knee, many believe that it just bends and straightens. When in reality there is actually a decent amount of rotation that is normal and should occur at the knee with various different tasks. 

This is because you hips and ankles have more degrees of freedom than the knee. Move your ankle or hip around for a moment. Then move you knee. Notice how many more options are available to the ankle and hip.

This puts your knee "a.k.a the middle man" at the mercy of the hip and ankle. Your body is like a tetor toter, if one end moves, the opposite end is going to do something as a result. 

So if you hip or ankle do not have the motion necessary to accomplish the task, it causes the knee to work overtime.

If your hip and ankle don't have stability and control, then the knee takes the brunt of the stress.

Your body needs controlled motion available throughout the lower extremity to distribute forces and start feeling better.

Listen to the video above, as I explain this in more detail. 

Real Solutions For Knee Pain| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

The #1 Reason Your Back and Hip Pain Has Not Resolved

People deal with low back and hip issues on a weekly and monthly basis. Unfortunately in some cases, low back and hip discomfort can be a daily struggle. 

Seemingly simple tasks such as bending forward to put your socks and shoes on, or transitioning in and out of your car become more difficult. In some cases, it's annoyingly uncomfortable. 

A lot of people will try various different stretches, strengthening, and stability based exercises to help improve their symptoms. They may even had tried massages or various different manual therapy techniques. These are all great ideas, and work well in a lot of cases. However, there is another subset of people who do not respond to typical measures of exercise and rehab. It is also very possible that if your noticing progress, but it just seems to be slow. There could be other factors you have not yet considered which has slowed or plateaued your progress.

In the video below, I'm going to be discussing one of these reasons.

It's not often NOT talked about by your rehab clinicians or personal trainers. It certainly is never discussed in the 15 minutes you get to spend with your primary care physician or orthopedic consult. And yet, it's one of the most basic things that all humans must be able to every day. 

If your still looking for answers and reasons for why your back or hip pain may be lingering around longer than you'd like, we at On Track Physiotherapy can provide answers and give you the time necessary for an explanation.

The first step is setting up a discovery visit so you know what to expect. We can answer any questions ahead of time, and if you feel that we are a good fit then we can move forward with treatment. Let us know the outcome you'd like to achieve, and we can tell you how our services can better help get you to that point. 

Low Back Specialist Physiotherapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Low Back Compression Explanation

Do you frequently wake up in the morning with a "tight" back?

Does your body just feel stiff and doesn't want to loosen up?

In this video we explain why people start to experience stiffness or tightness in their back that just doesn't want to ease up. 

The good news, is there are effective strategies to put a halt to this once and for all! Set up FREE discovery visit with On Track Physiotherapy to learn how.

3 Reasons Why Your Still Feeling Low Back Pain, Stiffness, and Tightness

Chronic low back pain, stiffness, and tightness is one of the most common things I see and treat in the clinic on a daily basis. 

If you are currently experiencing low back pain, stiffness, or tightness that just doesn't seem to go away. You are not alone. In fact, millions of people deal with this issue unfortunately on a daily basis in the United States.

Many misconceptions about low back pain exist from individuals giving generalized recommendations. In today's article, I will discuss 3 common reasons why you're still experiencing pain, stiffness or tightness in the low back that not many people talk about.

If you have ever been to the Doctor and been given diagnosis such as: degenerative disc disease, spinal stenosis, etc. you'll want to be sure to read all the way through. Too many healthcare clinicians give out diagnosis but don't ever explain what's going on and why your experiencing the current issues in the first place. If your going to try to solve a problem, wouldn't it make sense to first understand what the problem is?......

Reason #1 ) Your body craves stability and control. If you are unable to provide it with enough control actively (using your muscles) then it will find a way to do it passively (bones, joints, ligaments, etc). Muscles have a much greater capacity to recover than passive structures, especially in the long term. 

Reason #2) Does it feel like you are constantly arching your back? Take a look at the picture above. See how the hips shift forward, the beltline points downward, and the ribs point upward. This is a position of extension and compression. Which in and of itself is not a bad thing. We just don't want to live there 24/7. 

Anyways, you will find people who frequently stand, sit, walk, etc. in this position. As you can see from the lines drawn, this puts a lot of compression on the low back structures and creates a lot of tightness in those low back muscles. Said another way, if you are in that position frequently, you are relying on passive structures to support your body frequently.

Reason #3) Let's look at this position a little more.... Below is a picture of a pelvis and low back model with the joints in "neutral". Neutral is a relative term, because when you move so does your joints. 

However if you are relying on passive support systems and compression to create control then your body defaults to that positional strategy. Which is the picture below. Notice how the hips flare further out to the side and the back hip bones start to approximate toward midline reducing space.

Hopefully these pictures provide some clarity for you. Holding a pelvis model in one hand and taking a picture in the other is not an easy task, but I think you get the point....

Frequent extension, compression, and passive support lead to feeling achy, sore, stiff, and tight. On Track Physiotherapy is your solution to finding an active way to provide relief and stop the daily annoying nuisance your back is currently experiencing. 

Not yet ready to come in for a visit, no worries. But please get started doing something....Click below to get your free report on Low Back and Hip Pain. 

Low Back Specialist Physiotherapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

ACL Injuries and Prevention - Part 3

Here is video #3 in our series on box jumps to decrease the risk of ACL injuries and also to improve jumping performance. 

If you have not watched the previous two videos, you can do so below:

Part 1

Part 2

Remember these exercises alone are generally not the complete solution. This is just one piece of the puzzle and their are other aspects of training that should be addressed as well if you are looking complete recovery or do all you can to prevent an injury.

If you want more information on the topic, be sure click the image below to get your free tips report!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track PT and Performance in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

ACL Injuries and Prevention - Part 2

Last week I talked about some of the main causes of ACL injuries and why they occur at a rate of 3-4x more often in female athletes.  You can find that article along with our first jump training video HERE:

This week I’m posting the second video in a series of three showing how we begin jump training to a box.  This type of training can be used for ACL injury prevention and to enhance sports performance.  It’s also what we do post-surgically to get the athlete used to jumping again and landing safely.

The great thing about box jumps is that the forces on the knee are quite low because you are not coming all the way back down to the floor.  It’s also much easier because of this for the athlete to work on proper landing technique.

Before I get to the video though I thought I’d post a picture of what you don’t want your athletes knees to look like.

Looks fairly simple but let me assure you it can be quite challenging for many athletes – boys included.  Learning to jump and land correctly has been proven to help prevent ACL injuries and it must also be a huge focus of any post-surgical ACL rehabilitation program.

If you would like to learn more about how to recover from an ACL injury or just better prevent one from occurring, click on the free guide below!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track PT and Performance in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

ACL Injuries and Prevention

ACL injuries (anterior cruciate ligament) have been an epidemic in sports but even more so in women’s athletics.  Females are 3-4x more likely to tear their ACL than men.  There are several proposed theories on why this is so but for the purposes of this article and what we address here at On Track PT and Performance we will discuss the following:

  • Poor movement quality
  • Strength deficits
  • Landing mechanics

There certainly are other factors, but for brevity sake on this article these are what we tend to see most commonly. I’ll go more in depth in subsequent articles but for now here are the basics:

Poor movement quality

There are just certain joints in our bodies that need to be very mobile in order to get us through our daily activities and especially sporting activities like running, jumping, and cutting.  Don’t get me wrong – all of our joints need to move through their full range of motion for us to be efficient movers.  Some just need to be emphasized a bit more because of their tendency to become stiff while other areas of our body need a bit more stability/motor control.  Check out the picture below to get an idea of how this works – it’s called the Joint – by – Joint theory.

It’s a very simplified way of looking at things but it does often work out this way.  The knee joint needs to have a great deal of stability in all directions to prevent injury.  If the ankle and hip joints above and below are moving well then the knee joint will more likely stay within it’s accepted range of motion during athletic movements.  If the ankle and/or hip are stiff then the knee may just have to go outside of it’s normal boundaries to land from a jump or decelerate while cutting.  This is where things can go south in a hurry!

Strength deficits

There is plenty of research out there in the medical and physical therapy journals showing that strength deficits can lead to knee injuries, and in particular ACL tears. Years ago the main concern was the ration of strength between the quadriceps and hamstrings, which if it was below a certain level it could inhibit an athlete's ability to decelerate correctly leading to injury.

Lately the focus has been more on the hips and muscles of the ‘core’ and how weakness or lack of control in those areas can contribute to injury.  I’ll get more into the ‘how’ and ‘why’ in another article but it is a reality that needs to be addressed.

At On Track PT and Performance, we know that a comprehensive strength program must be implemented to assist in the prevention of ACL injuries.  Quality movement is critical for effective strength training as well.  Being able to combine these qualities is what we do best, and definitely one of my favorite things to talk about so more to come for sure!

Landing mechanics

It is also well documented that female athletes land and cut differently than the male athletes.  Women tend to land stiffer and higher than the men who typically land in deeper hip and knee flexion angles.  Stiffer and higher landings are more dangerous as far as the knee joint is concerned.

Strength and movement quality again play a large role in this.  Some athletes can’t even get into a good position to perform complex athletic movements.  Big problem!

Many don’t have the strength to get into the proper positions.  Another big problem.

As the athletic activities get faster, more complex, impose higher forces, etc it becomes more and more challenging to perform them using good technique.  Fortunately all of these qualities can be addressed through physical therapy and proper training techniques.

Check out the video below filmed by a good friend of mine Joe Heiler. We both use these methods to start teaching athletes to jump correctly using box jumps.  The nice thing about landing on a box is that you don’t really have to come all the way back down.  Much less strain on the knees and an easy way to work on jumping and landing technique.

If you would like to learn more about how to recover from an ACL injury or just better prevent one from occurring, click on the free guide below!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track PT and Performance in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Sciatica, Back Pain, and Associated Leg Pain

Sciatica, back pain, and associated leg pain can be really annoying to deal with. It can make simple tasks like sitting, sleeping, or walking a nightmare. Fortunately, we’ve had a lot of great success with these folks so thought I’d share a couple examples.

Often these issues can be difficult to treat (especially if you have been dealing with them for an extended period of time) but we like a challenge!  Always being mindful of how the location of the pain extending down your leg can be a dead give away as far as what area to target in treatment.

There are other ways to narrow down the location of the problem as well:

  • The muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • Reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve L4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So below are a couple great examples of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • Minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • Moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • Springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with IASTM to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and IASTM.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

If this sounds similar to you or would like some assistance in your recovery, then click the link below to receive a FREE discovery session.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi.

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3 Acceleration Drills To Build Speed for Football Players

Speed is important for any athlete. The ability to accelerate quickly is what can set a good and great athlete apart. Being able to get up into top speed quickly takes technique, strength, and power. With these three drills we are assuming you have been addressing the strength component of your workouts. This video will show you 3 acceleration/sprint dills you can do on the field, court, or track in order to improve technique to better allow for the transfer of strength into power. 

Want to improve athleticism and start dominating your competition?! Check out my free tips report below, designed to show you exactly what  youth and high school athletes need to include in their workouts!

Ankle Sprain Answer

Ankle sprains are one of the most common injuries.  Some have estimated that ~2,328 people sprain their ankle a day. For some individuals it takes months to recover, others a couple days/weeks.  In either scenario, the treatment of choice most people would have you believe is to rest and ice.  However, very rarely is resting the treatment of choice for any injury, but for whatever reason this seems to be the common recommendations given to individuals with ankle sprains.  This could be one reason why your recovery from an ankle sprain is taking so long. The other problem is that it often leads to limited ankle mobility down the road even if the pain is gone. Limited ankle mobility has further implication such as knee pain, ACL injuries, hip pain, and low back pain.

Unfortunately some individuals will experience frequent ankle sprains. Which can be frustrating, as they seem to happen more and more often. Preventing you from playing, practicing or performing the activities you enjoy on a regular basis.

So what should be done?

First, start moving in a pain free or tolerable range of motion, no matter how small this may start out to be. Also, a very effective treatment to try is submaximal isometrics.

Tip: Do not discount the effectiveness of this simple exercise and its ability to get rid of your pain and start to improve you walking quickly. As an added benefit, this strategy can often be started immediately after spraining the ankle to facilitate the healing process.

Finally, retraining your foot and ankle positional awareness is important to prevent future ankle sprains from occurring. When individuals experience frequent ankle sprains, most commonly they have a reduced ability to react to situations and stabilize the ankle for protection. In many circumstances, this exercise can be started day 1 as well as better help prevent you from experiencing frequent ankle sprains in the future.

If you would like to recover faster from ankle sprains and prevent future sprains from happening so you can stay active or playing the sport you enjoy. Check out the Ankle Sprain Answer.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

5 Secrets for Decreasing Low Back Pain… Without Medication or Visiting the Doctor

Secret #1 – Don’t Focus Just on the Back

Low back pain is a very common problem, and is a topic that comes up often when people find out that I am a physical therapist. The problem with low back pain is that there are a number of different factors that could be contributing to the issue. Without a thorough evaluation, it is impossible to give a direct recommendation. Please don’t think that I am trying to weasel out of the question, but low back pain is probably the most complex area to treat and generalized recommendations get generalized results. With that being said, the purpose of this document is to give you useful information and take home points that can help give you some relief today! If you understand the functions of the segments above and below the low back, a solid correction program can be initiated.

jt by jt.jpg

The picture above provides a simple summary of the movement capabilities in different areas of the body. Front and center is the low back, which as you can see, the main function in this area is stability. Above and below the low back are your hips and thoracic (mid) spine. Both of these segments require a great deal of mobility. If you think about this for a minute, it makes perfect sense. The joints with the greatest natural range of motion and degrees of freedom are intended to be mobile, and those with limited ranges are intended to be stable. If areas that are supposed to be mobile do not function optimally, then the body is going to have to create the mobility somewhere else. Most of the time this happens at the expense of areas that are intended to be predominantly stable (in this case the back).

Secret #2 – Start Moving

One of the biggest mistakes some people make after getting back pain is they stop moving completely because they are afraid of making it worse. The problem with this is that if you want to get out of pain, you’re going to have to start moving at some point. Doing absolutely nothing will do absolutely nothing to give you relief. It may sound obvious, but find different movements and positions that don’t cause as much pain then repeatedly get into those positions and movements until things start to ease up a bit. When your back or hip pain is affecting the way you walk, sit, get out of a chair or drive, its definitely time to do something so this doesn’t last longer than it needs to for recovery. Below is a very simple example that often times many people can start doing early on in their recovery process.

Secret #3 – The Easiest Way to Start Moving

I realize point #2 and #3 are the same thing. This was done on purpose, because I like action takers and people who are proactive about getting better. Now as prefaced in this guide, back pain can manifest itself in a variety of ways and a variety of intensities. So if your back pain is severe, be sure to start this exercise out slowly in a small range of motion and move on from there. If you feel your pain is worsening, please use common sense and stop (it should go without saying, that this exercise may not be for everyone). With all that being said, here is one of the easiest exercises I have found to start easing back pain and get someone moving again after treating hundreds of people over the years with back pain.

Secret #4 – Ease Back Pain by Reducing Compression on the Back

You are probably asking “how can I do this?” Or “how do I know if this is a problem?”

The simplest way of telling if you are naturally too extended or compressed in the back more so than normal is to lay flat on your back and look at your ribcage. If you identify a large rib flare on one or both sides, this could be playing a role in your back and hip symptoms. Below is a picture of what I am talking about.

Here is a simple exercise that you can do to help combat this issue and relieve some compression at the back. Note: this exercise is only scratching the surface on how we can address this issue.

Secret #5 – Movement Assessment

Having a trained eye watch how you move through different ranges of motion and see where limitations might exist in hips, spine, among others. This will often direct which set of particular exercises and potentially manual therapy techniques would be most important for your particular set of limitations. Sometimes generalized exercise and soft tissue work will not do the trick. This is why we at On Track Physical Therapy will take you through a movement assessment every visit and multiple times per visit. It allows us to be very targeted in what we do as opposed to throwing things out and hoping something sticks. This allows us to help you get off painkillers, get some sleep, and continue to move as fast as possible. If that sounds like something you’d enjoy, then let us know by filling out this quick questionnaire below and inquire about a FREE Discovery Visit.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Sprint Training For Beginners (Part 3)

These exercises will build further upon the previous exercises listed below. So if you have not watched them, check them out first.
Part 1: https://youtu.be/ikGkgWFh4fA
Part 2: https://youtu.be/LONKdUZ6Mao

In part 3 we include two exercises that start to incorporate reactiveness into the exercise. The hop prior to starting will initiate the stretch shortening cycle upon landing to start working the elastic component of the achilles as well as up the chain to initiate a sprint. By performing this in both the forward and lateral start postures it teaches the athlete how to really push off and get into the drive phase of acceleration. Using the bounce is another way to facilitate proper angles while working on strength and power eventually needed later on from a 3 point start.

To learn more about how you can improve athleticism and start dominating your competition. Check out my free tips report for athletes below.

Stop Daily Annoying Knee Pain Without Taking Painkillers Or Having Surgery

Knee pain is one of the most commonly treated and surgically operated injuries in the world. It impacts you daily by making stairs or frequent lifting a nightmare. It might be stopping you from playing a sport with your child or going for a round of golf with your buddies.  Maybe you have had an x-ray performed, and been told you have degeneration or arthritis in your joint? While x-rays certainly do not lie, they also do not tell the entire story.

In fact, one study by Katz and fellow researchers showed that getting physical therapy first helped 60%-70% of knee osteoarthritis patients avoid surgery.  

Another study of 180 patients with osteoarthritis were separated into three groups: two different types of arthroscopic surgery, and a placebo (fake) arthroscopic surgery. Interestingly, the two arthroscopic surgeries were no more effective than the placebo (fake) surgery.

Staggering information isn’t it? That’s a lot of money to throw at a surgery with questionable outcomes. Not to mention you probably will have to go to therapy after surgery anyways. Fortunately to both you and me “arthritis” is a normal change in the body that happens over years of accumulated stress and as a result can often be improved through conservative measures.

Why Does My Knee Still Hurt?

The knee often takes the brunt of the force for lack of mobility or control in the hip or ankle. The degrees of freedom in the knee are much less than the ankle or the hip. If motion limitations exist in the hip or ankle, the knee will start creating wear patterns as a result. This wear pattern typically presents itself in some form of faulty orientation of the knee. The body will always take the path of least resistance. So if the hip and ankle orientation are not optimal due to restrictions, this creates a twisting mechanism at the knee as it tries to adapt and accommodate for other structures that are not functioning at optimal capacity.

As you can imagine, this makes the knee much less adaptable and resilient.

Maybe you have had a previous injury to the knee? If optimal function and adaptability was never restored in the knee afterwards, then the overall level of resiliency to injury of the knee will remain low as well.

So how do we reduce pain in the knee so you can squat, go up and down stairs, and walk without that annoying pain?

1) Perform exercises that will get the muscles around the hip strong. This program is often much trickier than going to the gym and working out. Remember we have adaptive changes to deal with that have occurred in the body as a result of dysfunctional or overused movement patterns (most likely both).

Because the body currently has a very low level of resiliency we need to be careful of the amount of load applied to the knee. This is one reason why a low impact endurance program can be very beneficial such as riding a bike 10-30 minutes a couple times per week at about 75% effort. In fact, a lot of research has actually shown that endurance training can increase pain tolerance.

But ultimately, we need to gradually start to load the knee again in a functional way to improve tolerance to activity. We can do this by improving hip function, this will help take some of the stress off of the knee. Here are a couple options that may be helpful. 

As part of a physical therapy treatment, we can perform different manual techniques such as dry needling that can help modulate pain. However, if we never address other limitations above and below the knee joint, the pain may remain or linger much longer than necessary. This is why a detailed assessment is required, so specific interventions can be given to restore optimal function and abolish pain.

Looking at the way you move through different ranges of motion and see where limitations might exist in both the hip and ankle. This will often direct which set of particular exercises and manual therapy techniques would be most important for your particular set of limitations. This is why we at On Track Physical Therapy will take you through a movement assessment every visit and multiple times per visit. It allows us to be very targeted in what we do as opposed to throwing things out and hoping something sticks, which unfortunately is what many other providers do. This allows us to help you get off painkillers, get some sleep, and keep an active lifestyle. If that sounds like something you’d enjoy, then schedule an appointment or a FREE discovery session to take things for a test drive.  

References

Katz, Jeffrey N., et al. "Surgery versus physical therapy for a meniscal tear and osteoarthritis." New England Journal of Medicine 368.18 (2013): 1675-1684.

Moseley, J. Bruce, et al. "A controlled trial of arthroscopic surgery for osteoarthritis of the knee." New England Journal of Medicine 347.2 (2002): 81-88.

Jones, Matthew D., et al. "Aerobic training increases pain tolerance in healthy individuals." Med Sci Sports Exerc 46.8 (2014): 1640-7.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Stop Achilles Tendinitis and Foot Pain BEFORE it causes another Problem

Have you ever heard someone say that after they hurt such and such body part that all of a sudden a whole slew of other injuries started?

I hear this all the time, and there is a lot of truth behind it. Especially when it comes to the foot and achilles tendon!

You see the foot is the body’s first line of defense to absorb and transmit force, your achilles tendon plays a major role in this. The foot hits the ground first thing in the morning and with every step you take during the day it must absorb and transmit force. However, when injured this capability becomes impaired.

So what happens when you have achilles pain? The body says “next man up”. Meaning your knee, hip, and back on either side start to take the brunt of the impact. If you do this repetitively, there is a pretty good chance something will start getting a little cranky.

I’ve treated a variety of Achilles injuries. Runners with chronic Achilles pain, partial tears, and post-surgical clients. I can tell you from firsthand experience that individuals who have been dealing with this for a prolonged period of time tend to have other issues as well. Most common tends to be the opposite hip from working overtime, but it could manifest itself in other forms as well.

 Achilles Tendon Injury (bottom)

Achilles Tendon Injury (bottom)

Often times the problem with these individuals is that they have been performing the same stretches over and over again for months on end without much improvement in symptoms or overall ability because that is what their doctor, PT, or Chiropractor told them to do.

Stretching could be part of the solution. However, chances are if you have not made improvement by now, then that is not the answer. Remember how I said the Achilles tendon's job is to absorb and transmit forces? Well stretching does not necessarily accomplish this mechanism. Think about a rubber band. The more you stretch it, the more it becomes loose and decreases its ability to create force or tension. The same concept applies to your tendons. Don't get me wrong, they need a baseline level of flexibility, but more does not necessarily mean better.

The solution? Creating useful stiffness and strength in the tendon so that it has the resiliency to absorb force all day long when you are walking, going up/down stairs, jogging, or playing a sport.

You have probably seen a calf raise before. This exercise, especially done at particular tempos and angles proves to be effective for a lot of people. However, a lot of times people will have pain with this activity so it makes it really hard to progressively load the tendon.

At On Track Physical Therapy we also utilize a method called blood flow restriction training. This allows us to make strength gains with very low loads of resistance. Research has also shown how it can increase human growth hormone (this hormone has been known to improve tendon recovery).

Another method for pain reduction used is Dry Needling. Which has been shown to improve pain in the short term. Allowing us to effectively strength train the tendon in a more pain free environment.

Finally, if you are an athlete, you need to progressively start including dynamic exercises and drills that will ultimately translate to sport by improving your body’s ability to efficiently transmit forces. Such as the exercises below:

 

For free tips on how the pros recover faster from injury, click the picture on the left. If you'd like to get help AS SOON AS possible then enquire about a FREE discovery session below.

 

 

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Basketball Weight Training Workout | Athlete Workouts Episode 5

This was a workout that is designed specific for basketball players to improve the athletes ability apply a vertical force. Prior to performing this workout, the athlete should have already established a proper squatting pattern and have prerequisite levels of strength through a full squat. 

This workout demonstrates a partial squat because that is what is encountered more in a basketball environment, in particular when we talk about vertical jump. A box jump is added as well for a plyometric after the lift for post activation potential. We follow this up with some tempo squats with eccentric focus and sled drags.

Foundation Program - http://physicaltherapyontrack.com/athletes/

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Sprint Training For Beginners (Part 2)

Part 1: https://youtu.be/ikGkgWFh4fA

In part two we are working on a 2 point start and a lateral start. Neither of these exercises utilize momentum (like in part 1) to help the athlete obtain proper body positioning.

Coach the athlete to drive away from the line and punching their knee forward. Body should rise naturally and over a period of time such as an airplane rising for take off.

Foundation Program - http://physicaltherapyontrack.com/athletes/

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Sprint Training For Beginners

These are two sprint variations that I will use with my athletes when they are first learning how to sprint.

Often times coaches will have athletes start to low (or simulating like they are coming out of the blocks). However the problem with this is the athlete is often not strong enough to power out from this position to obtain the proper shin and torso angles for acceleration.

By using a momentum start or falling starts you can get the athletes into better positions for acceleration until their strength levels start to increase enough to go down into a 3 point or 4 point stance.

For FREE Training Tips click the picture below and sign up to download your report today!